Meet the Health team in Sahiwal, Pakistan

“I did not have a job before joining BRAC. Now I am a Health Worker with BRAC in Sahiwal. I joined BRAC to give service to humanity” – Nasreen, a newly recruited Health Worker with BRAC Pakistan’s Health Program in Sahiwal, Punjab.

“Mothers come to me even at two o’clock in the morning,” says Farkhanda, a Health Worker (HW) with BRAC’s Health Program in Sahiwal, Pakistan. The BRAC Health Program in Pakistan is still very new – the program in Sahiwal began only in the fall of 2009, but it already covers 9000 households.

BRAC has conducted extensive door-to-door surveys in the target communities, recruited HWs like Farkhanda, and created a team of Health Volunteers (HVs). Each HV lives in proximity of the households they cover, and she visits them door-to-door and serves them inside their homes.

Farkhanda tells us “Now we have 60 Health Volunteers, each covering a cluster of 150 households. They know each household well, from their routine door-to-door visits to each home once to twice a month. Often the locals come to the homes of the Health Volunteers (HVs), which is easy because each HV has a BRAC signboard prominently displayed outside their home.”

The HVs and HWs were given extensive technical and field work training in October so as to equip them to deliver quality services to the community. They are knowledgeable and equipped to address many common illnesses that can be treated effectively with common medicines. They are also educated on many basic health matters, such as sanitation, family planning, ante/post natal care, vaccinations, respiratory and stomach illnesses. They attend regular refresher courses to stay current on new health matters.

As HVs have become the first point of contact for reporting any health problem in the households of the local community, they are also the first and primary source of new health information. For example, the government campaign against malaria and polio that began just before year end came to be known to the community first through the BRAC HVs that regularly serve them. BRAC adopted the messages in the government’s malaria and polio campaigns and educated the members on these diseases through door-to-door visits to members, and at the community health forums.

Similar to what BRAC health volunteers successfully do in Bangladesh and other countries,
HVs in Pakistan will begin selling basic health products to the households under their coverage in January 2010. Examples of such products to be sold include oral rehydration salts, sanitary napkins, condoms, cold and fever medicines, and other common medicines. This gives the HVs opportunities to earn income for their work, and effectively turns their homes into mini-dispensaries in an area where such dispensaries are sorely lacking.

Shaheen did not know about BRAC until a HV came to do household surveys in her community. She is a teenager and was already pregnant with her first child when she initially met her community’s Health Volunteer. “I would not have learned what I’m learning now about antenatal and prenatal care without my BRAC HW and HV. I am very close to them. Maybe I could have learned the same things from TBAs, but they are few in number, and are not very knowledgeable. I am learning new things, and this is very helpful. The Health Forum meetings are only a five-minute walk from my home. After I give birth, I also want to become a BRAC Health Volunteer.” Her mother-in-law is also working as a volunteer with the BRAC Health Program.

With so many health messages being projected to the community by health forums and household visits by the HVs and HWs, are people learning what is being taught? “Yes” says Farkhanda, one of six HWs in Sahiwal. “We are overwhelmed with questions from the mothers, so definitely they are actively learning.”

There are also signs of women taking collective action based on what they are learning. Farkhanda says “Recently, women that we work with from one neighborhood decided to clean on their own the streets and gutters of their slum. It’s the government’s responsibility but they don’t do it, so the women did it on their own because they know from BRAC how important hygiene and sanitation is.”

Promoting family planning is still a challenge. “In Sahiwal, about 40% of families still resist family planning” Nasreen says. “Their negative attitudes to family planning come from not knowing the choices that are available. We try to educate them about the various family planning alternatives and the benefits of each to the families. We also use religious arguments in support of family planning. Our religion says maternal health is important. The religious books say that a child needs to be breast-fed for at least two years and six months before the mother gives birth to another child. Therefore, Islam tells us that family planning is essential.”

“Providing members with necessary unfamiliar medicines is sometimes difficult too” says Nargis, a HV that works under Nasreen. “Some people say that medicines cause people to get sick. We know that medicines can have side effects, but we talk to them about people they know who became healthy after taking medicines when they were sick.” The medicines provided by our BRAC health volunteers are all selected and suggested by the Registered Medical practitioners. The side effects of such medicines are minimal, and they are informed to the patient before consumption.

Speaking about her job, Farkhanda says “Before I became a HW, I was a teacher. I also have two children at home. I joined BRAC in September to get trained as a HW, and now I love my job. My husband is also very happy with the job I do with BRAC.”

Just before year-end, BRAC Pakistan launched the same health program in the Nowshera district of North West Frontier Province (NWFP). In an area like NWFP where the society is very conservative, the need for women’s empowerment is even greater. With recruitment and training of HWs and HVs complete, BRAC is working to build trust, educate, and create awareness about the health program and the benefits and opportunities it has for them and their families.

BRAC Pakistan’s expanding its health program, especially in a high-risk area like NWFP is a great motivating factor for the staff. “My family was opposed to my decision to join BRAC. They wanted me to take a stable government job. But I took the BRAC job because my heart wants to be in the service to the people,” says Muhammad Luqman, a Regional Health Coordinator for BRAC Pakistan’s health program.